Current situation and challenges of community-based rehabilitation in depopulated areas

The aim of this study was to clarify the current situation and challenges of community-based rehabilitation (CBR) in depopulated areas from the perspective of physicians and to develop a model suited to such contexts. Semi-structured interviews were conducted with physicians and other healthcare professionals working at Clinic B in City A, a rural setting facing population decline. Interview transcripts were analyzed using qualitative content analysis. A total of 34 coding units and 14 contextual units were identified, which were then synthesized into five major categories: [Structural Challenges and Innovations in Regional Healthcare Systems], [Specialized Evaluation and Service Delivery], [Interprofessional Collaboration and Communication], [Patient-Centered Philosophy], and [Professional Competence and Community Culture]. From these categories, a core concept emerged? “A Community-Based Rehabilitation System that Creatively Transcends Constraints.” At the center of this model lies “Patient-Centered Shared Decision-Making,” in which physicians retain ultimate medical responsibility while respecting patient autonomy and collaborating with other professionals through information and communication technology (ICT). The model conceptualizes the community as an integrated care space, where multidisciplinary collaboration and creative problem-solving transform local resource constraints into opportunities for innovation. This approach enables healthcare providers to adapt flexibly to structural and workforce limitations while preserving high-quality, patient-centered care. The framework offers a practical strategy to support residents’ wish to “remain in their community until the end of life,” reframing rural healthcare challenges as drivers of innovation. These findings contribute to both the academic understanding and the practical advancement of integrated community care systems in aging societies.